Management of Extra-articular Proximal- third Tibia Fractures by Expert Tibia Nail and its Functional Outcome: A Longitudinal Cohort Study

Abstract

Introduction: Tibia, being anatomically placed subcutaneously throughout its length, is very prone to fractures. Incidence of extra-articular proximal tibia fractures accounts for 5-11% of all tibia shaft fractures. Among the various treatment modalities available, locked intramedullary nailing is a safe and adequate modality with fewer complications. Expert tibia nail is anatomically designed with multi-directional locking, which attains better angular stability and thereby allowing fixation of very proximal fractures. Aim: To analyse and assess the functional and radiological outcome of expert tibia nailing used for treating extra-articular proximal-third tibia fractures. Materials and Methods: A longitudinal cohort study was conducted for a duration of three years and five months, which included 31 patients. Standard descriptive statistical method was used to describe parameters. All these patients had extra-articular proximal- third tibia fractures and were managed with expert tibia nail. All patients underwent clinical and radiological evaluation based on the Klemm and Borner scoring system at a regular interval of six weeks, three months, six months, and at one year. Results: The most common mode of injury was road traffic accidents (80.64%). Patients were in the age group of 26-63 years with an average mean of 41.80±9.7 years. The male to female ratio was 4.16:1, suggestive of male predominance. According to the Klemm and Borner scoring system, 71.42% of patients belonged to the excellent group, 17.85% were in good, 7.14% in fair and 3.57% in poor. Radiological union was achieved in an average period of 20.9±2.09 weeks. Conclusion: In this study, scores obtained on the basis of Klemm and Borner scoring system, depicts that intramedullary expert tibia nailing is a good treatment modality for the management of extra-articular proximal-third tibia fractures, which provides good angular stability and adequate fixation resulting in early rehabilitation and union with excellent functional outcome and mere complications. It is also a safer treatment modality in case of compromised surrounding soft tissue.